Thoracic manifestations of systemic lupus erythematosus

##plugins.themes.academic_pro.article.sidebar##

Published Mar 4, 2011
Download
pdf
Vol. 89 No. 3 (2011): Issue Mar 2011

##plugins.themes.academic_pro.article.main##

Leila Fekih
Leila Boussoffara
Soumaya Chaouachi
Soraya Fenniche
Hajer Abdelghaffar
Ines Akrout
Hela Hassene
Dalenda Belhabib
Service de pneumologie Ibn Nafiss. Hôpital Abderrhmane MAMI de L'ARIANA
Mohamed Lamine Megdiche

Abstract

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease. The respiratory system is more commonly involved in SLE than in any other collagen vascular disease.
Aim: To study the pleuropulmonary manifestations of SLE.
Methods: Retrospective study including 10 patients hospitalized between January 2000 and December 2008 for pleuro-pulmonary manifestation revealing or complicating the SLE.
Results: Nine women and only one man aged between 21 and 67 years-old were included in this study. Two patients had already SLE and for the other patients the pleuro-pulmonary manifestations were revealing the SLE. Pleural effusion was the most common manifestation witch represents 50% of the patients. For the other patients we find one case of interstitial pneumonia, one case of pulmonary embolism, on case of pneumonia, on case of pulmonary haemorrhage and on case of pulmonary hypertension. All these patients were treated by corticoids and only one patient takes high doses of corticoids for managing a massive pulmonary haemorrhage.
The evolution was favourable for 9 patients, one patient dead because of massive pulmonary haemorrhage complicated with acute respiratory failure.
Conclusion: Pleuro-pulmonary involvement in SLE is common and may be life threatening, in which case prompt and aggressive treatment is mandatory

Keywords:

Systemic lupus erythematosus, lung, pleural effusion, evolution, prognosis

##plugins.themes.academic_pro.article.details##

References

  1. Meyer O. Lupus érythémateux systémique. Encycl Med Chir, Paris. Rhumatologie-Orthopédie 2005 ; Volume 2, Issue 1: 1-32.
  2. Haupt HM, Moore GW, Hutchins GM. The Lung in Systemic Lupus Erythematosus: Analysis of the Pathologic Changes in 120 Patients. Am J Med 1981 ; 71 :791-8.
  3. Carmier D, Marchand Adam S, Diot P, Diot E. Atteinte respiratoires au cours du lupus érythémateux systémique. Rev Mal Resp 2008.25:1289-303.
  4. Guo H, Leung JCK, Chan LYY, Chan TM, Lai KN. The pathogenetic role of immunoglobin G from patients with systemic lupus eryhteamtosus in the development of lupus pleuritis. Rheumatology 2004; 43:286-93.
  5. Elborn JS, Conn P, Roberts D. Refractory massive pleural effusion in systemic lupus erythematosus treated by pleurectomy. Ann Rheum Dis 1987; 46 :77-80.
  6. Evans SA, Hopkinson ND, Kinnear WJM, Watson L, Powel RJ, Johnston IDA. Respiratory disease in systemic lupus erythematosus: correlation with results of laboratory tests and histological appearance of muscle biopsy specimens. Thorax 1992; 47:957-60.
  7. Miller LR, Greenberg SD, McLarty JW. Lupus Lung. Chest 1985; 88:265-9.
  8. Kerbouc'h JF, Cledes J, Garre M, Zabbe C, Gouva S, Clavier J. Pneumopathies aiguës mortelles au cours du lupus érythémteux déssiminé. Rev Pneumol Clin 1988 ; 44:6-13.
  9. Keane MP, Lynch III JP. Pleuropulmonary manifestations of systemic lupus erythematosus. Thorax 2000; 55:159-66.
  10. Cha SI, Fessler MB, Cool CD, Schwarz MI, Brown KK : Lymphoid interstitial pneumonia: clinical features, associations and prognosis. Eur Respir J 2006; 28: 364-9.
  11. Hedgpeth MT, Boulware DW. Interstitial pneumonitis in antinuclear antibody-negative systemic lupus erythematosus: a new clinical manifestation and possible association with anti-Ro (SS-A) antibodies. Arthritis Rheum 1988; 31: 545-8.
  12. Orens JB, Martinez FJ, Lynch JP, 3rd : Pleuropulmonary manifestations of systemic lupus erythematosus. Rheum Dis Clin North Am 1994; 20: 159-93.
  13. Langford CA, Sneller MC, Hoffman GS. Methotrexate use in systemic vasculitis. Rheum Dis Clin North Am 1997; 23: 841-53.
  14. Habibagahi Z, Ali Nazarinia M, Aaflaki E, Ali Ostovan M, Hadi Bagheri M. Systemic lupus erythematosus and hyper-eosinophilic syndrome: an unusual association. West Indian Med J. 2009; 58:69-71.
  15. Nossent JC, Berend K. Cricoarytenoiditis in systemic lupus erythematosus. Scand J Rheumatol 1998; 27: 237-8.
  16. Eichacker PQ, Pinsker K, Epstein A, Schiffenbauer J, Grayzel A : Serial pulmonary function testing in patients with systemic lupus erythematosus. Chest 1988; 94: 129-32.
  17. Liu MF, Lee JH, Weng TH, Lee YY. Clinical Experience of 13 cases with Severe Pulmonary Hemorrhage in Systemic Lupus Erythematosus with Active Nephritis. Scand J Rheumatol 1998 ; 27:291-5.
  18. Piette JC, Cacoub P, Karmochkine M, Godeau P. Le syndrome des antiphospholipides et le pneumologue. Rev. Pneumol. Clin. 1994 ; 50:99-105.
  19. Abramson SB, Dobro J, Eberle MA et al. Acute Reversible Hypoxemia in Systemic Lupus Erythematosus. Ann Intern Med 1991 ; 114 :941-7.
  20. Porges AJ, Beattie SL, Ritchlin C, Kimberly RP, Christian CL. Patients with sytemic lupus erythematosus at risk for pneumocystis carinii pneumonia. J Rheumatology 1992; 19:1191- 4.
  21. Kim JS, Lee KS, Koh EM, KIm SY, Chung MP, Han J. Thoracic Involvement of Systemic Lpupus Erythematosus : Clinical, Pathologic, and radiologic Findings. J Comput Assist Tomogr 2000 ; 24:9-18.
  22. Meyer O, Dusser D, Aubier M, Chretien J, Ryckewaert. Dysfonctionnement diaphragmatique au cours de la maladie lupique. Presse Med 1986; 15:844.
  23. Elkhayam O, Segal R, Caspl D, Yaron M, Greif Y. Restrictive lung disease due to diaphragmatic dysfunction in systemic lupus erythematosus. Two case reports. Clin Exp Rheumatol 1992; 10 : 267-9.
  24. Asherson RA, Higenbottam TW, Xuan ATD, Khamashta MA, Hughes GRV. Pulmonary Hypertension in a Lupus Clinic: Experience with Twenty-Four Patients. J Rheumatol 1990; 17 : 1292-8.
  25. Pines A, Kaplinsky N, Olchovsky D, Rozenman J, Frankl O. Pleuro-pulmonary Manifestations of Systemic Lupus Erythematosus: Clinical Features of its Subgroups Prognostic and Therapeutic Implications. Chest 1985; 88:129-35.
  26. Eiser AR, Shanies HM. Treatment of lupus interstitial lung disease with intravenous cyclophosphamide. Arthritis Rheum 1994 ; 37 :428-31.